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1.
Chung SG van Rey E Bai Z Rymer WZ Roth EJ Zhang LQ 《Archives of physical medicine and rehabilitation》2008,89(4):700-710
Chung SG, van Rey E, Bai Z, Rymer WZ, Roth EJ, Zhang L-Q. Separate quantification of reflex and nonreflex components of spastic hypertonia in chronic hemiparesis.
Objectives
To isolate and quantify reflex and nonreflex components of the spastic ankle plantarflexors in hemiplegia poststroke and to correlate them with clinical measures of spasticity, which may involve hyperactive stretch reflex and/or increased joint stiffness.Design
To investigate reflex and nonreflex properties associated with spasticity in a case-control manner.Setting
Research laboratory in a rehabilitation hospital.Participants
Hemiplegic patients (n=17) and the same number of healthy subjects.Interventions
Not applicable.Main Outcome Measures
Tendon reflexes of spastic muscles were evaluated under an isometric condition, which essentially eliminated passive viscoelastic contributions associated with limb movement. Nonreflex components of spasticity were evaluated by moving the ankle joint slowly, which minimized reflex actions. The reflex and nonreflex measures were investigated and correlated with each other and with clinical measures.Results
Compared with healthy subjects, patients with stroke showed a lower reflex threshold, higher electromyographic gains, and torque reflex gains, indicating hyperactive reflexes. For nonreflex properties, ankles of stroke patients showed higher stiffness, reduced range of motion (ROM), and larger resistant torque at comparable positions, reflecting peripheral soft-tissue changes at the ankle of the chronic stroke patients. Furthermore, the clinical reflex score correlated with all of the quantitative reflex measures but not with the nonreflex measures, whereas the dorsiflexion ROM showed a significant correlation with a nonreflex measure. The Modified Ashworth Scale was correlated with all of the reflex measures and 1 of the nonreflex measures.Conclusions
Comprehensive and convenient evaluation of spasticity should be performed quantitatively with the separate measures of reflex and nonreflex components, especially in chronic conditions. With proper simplifications, the current method of separate quantification can potentially be used for convenient clinical evaluations of spasticity. 相似文献2.
Josien C. van den Noort Vanessa A. Scholtes Jules G. Becher Jaap Harlaar 《Archives of physical medicine and rehabilitation》2010,91(4):615-623
van den Noort JC, Scholtes VA, Becher JG, Harlaar J. Evaluation of the catch in spasticity assessment in children with cerebral palsy.
Objective
To evaluate whether the catch in clinical spasticity assessment in cerebral palsy (CP) is the consequence of a sudden velocity-dependent increase in muscle activity, resulting from hyperexcitability of the stretch reflex in spasticity.Design
Cross-sectional study.Setting
A special school for children with physical disabilities.Participants
Children with CP (N=20; age range, 5-14y; mean weight ± SD, 35±14kg; mean length ± SD, 139±19cm).Interventions
Spasticity assessment tests (using slow and fast passive stretch) were performed in the medial hamstrings, soleus, and medial gastrocnemius muscles of the children by 2 experienced examiners.Main Outcome Measures
Surface electromyography (EMG) was recorded and joint motion was simultaneously measured using 2 inertial sensors. The encounter of a catch by the examiner was compared with the presence of a sudden increase in muscle activity (“burst”). The average rectified value (ARV) of the EMG signal was calculated for each test.Results
The study shows a sudden increase in muscle activity in fast passive stretch, followed by a catch (hamstrings 100%, soleus 95%, gastrocnemius 84%). The ARV in slow passive stretch was significantly lower.Conclusions
The results confirm that in children with CP, an increase in muscle activity is primarily responsible for a catch in fast passive muscle stretch. 相似文献3.
4.
Jacob J. Sosnoff Sunghoon Shin MS Robert W. Motl PhD 《Archives of physical medicine and rehabilitation》2010,91(1):93-99
Sosnoff JJ, Shin S, Motl RW. Multiple sclerosis and postural control: the role of spasticity.
Objectives
To examine the association between spasticity and postural control in subjects with multiple sclerosis (MS).Design
Cross-sectional.Setting
Motor control laboratory.Participants
Subjects with MS (n=16, 2 male) and age and sex-matched subjects (n=16) participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth scale scores between 1 and 3.Interventions
Not applicable.Main Outcome Measures
Postural control was measured with a force platform that quantifies ground reaction forces and moments in mediolateral and anteroposterior directions. Postural control was indexed with anterior-posterior sway range, medial-lateral sway range, 95% elliptical area of the deviations of center of pressure (COP), velocity of COP sway, and the frequency at which 95% of spectral profile was contained. Participants with MS further underwent assessment of the soleus Hoffman reflex (H-reflex) as an index of spasticity.Results
Cluster analysis on H-reflex data identified groups of MS participants with high spasticity (n=7) and low spasticity (n=9). There were no differences in age, duration of MS, and disease severity between MS groups. There were no differences in anterior-posterior sway range between any of the groups. The high spasticity group had greater COP area, velocity, and mediolateral sway compared with the low spasticity and control group, and the low spasticity group had postural control values between the high spasticity and control groups.Conclusions
The pattern of results suggests that spasticity contributes to postural deficits observed in MS. 相似文献5.
Tanya Onushko Allison Hyngstrom Brian D. Schmit 《Archives of physical medicine and rehabilitation》2010,91(8):1225-1235
Onushko T, Hyngstrom A, Schmit BD. Effects of multijoint spastic reflexes of the legs during assisted bilateral hip oscillations in human spinal cord injury.
Objective
To investigate the timing and magnitude of muscle activation during an active-assist bilateral hip motor task in human spinal cord injury (SCI).Design
A single test session using a novel robotic system to alternately flex and extend the hips from 40° of hip flexion to 10° of hip extension at 1 of 3 frequencies (.25, .50, .75Hz). Subjects were asked either to actively assist the movements or to remain relaxed during the imposed oscillations.Setting
All data were collected in a research laboratory.Participants
Ten subjects with motor incomplete (American Spinal Injury Association grade C or D) SCI and 10 individuals without neurologic injury participated in this study.Interventions
Not applicable.Main Outcome Measures
Electromyograms and joint torques were recorded from the lower extremities of SCI subjects and compared with electromyograms and joint torque patterns recorded from 10 neurologically healthy individuals completing the same tasks.Results
In trials involving active assistance of the imposed hip oscillations, SCI subjects produced muscle activation patterns that were phased differently from muscle activity of neurologically intact subjects. SCI subjects generated peak torque at the end ranges of movement (ie, 40° hip flexion, 10° extension), whereas control subjects generated the greatest torque midway through the movements. Moreover, the phasing of active-assist hip torque in SCI subjects was similar to the phasing of reflexive hip torques produced during the unassisted condition (ie, SCI subjects instructed to relax), while control subjects produced no reflexive torques during unassisted trials.Conclusions
The differences in the timing of muscle activity during the active-assist task in controls and SCI subjects highlights problems in generating appropriately timed muscle activity during ongoing movements. The similarity in muscle activity patterns for the active-assist and unassisted trials in SCI subjects further suggests that reflex feedback from hip afferents contributes substantially to muscle activation during active-assist movements. These findings demonstrate the disruptions in reflex regulation of movement in people with incomplete SCI and suggest that spastic reflexes might disrupt motor control. 相似文献6.
Mark Braschinsky Kadri Parts Heigo Maamägi Katrin Gross-Paju Sulev Haldre 《Archives of physical medicine and rehabilitation》2009,90(11):1887-1890
Braschinsky M, Parts K, Maamägi H, Gross-Paju K, Haldre S. Functional assessment of lower extremities in hereditary spastic paraplegia.
Objectives
To characterize the spasticity and range of motion (ROM) in patients with hereditary spastic paraplegia (HSP) and to correlate these parameters with walking speed.Design
An observational population-based cohort study.Setting
Patient data were acquired from a population-based epidemiologic study performed earlier in Estonia.Participants
Persons (N=46) (mean age, 50.1y) with clinically confirmed HSP diagnosis (mean duration, 20.9y) participated in the study.Interventions
Active and passive ROMs were measured with a plastic 360° goniometer. Spasticity was evaluated by using the modified Ashworth scale (MAS). The time it took a patient to walk 10m was recorded.Main Outcome Measures
Measurements included testing of active and passive ROM as a marker for mobility, the MAS for spasticity, and time to complete a 10-m walk.Results
A higher degree of spasticity in hip muscles was associated with lower values of active ROM and slower walking. Walking speed was negatively correlated to disease duration and participant age.Conclusions
The present study provides analysis of the contributions of spasticity and ROM to walking speed in HSP, both factors negatively influence gait in persons with HSP. 相似文献7.
Thierry Deltombe Thierry Gustin 《Archives of physical medicine and rehabilitation》2010,91(7):1025-1030
Deltombe T, Gustin T. Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases.
Objective
To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients.Design
Intervention study (before-after trial) with an observational design and 2-year follow-up.Setting
Spasticity group in a university hospital.Participants
Hemiplegic patients (N=30) with spastic equinovarus foot.Intervention
A selective neurotomy was performed at the level of the motor nerve branches of the tibial nerve.Main Outcome Measures
Spasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion, gait parameters (6 min walking test), and gait kinematics (video assessment) were assessed before and at 2 months, 1 year, and 2 years after selective tibial neurotomy.Results
Compared with preoperative values, there was a statistically significant decrease in triceps surae spasticity, an increase in gait speed, and a reduction in equinus and varus in swing and stance phases at 2 months postoperatively. This improvement persisted at 1 and 2 years after selective tibial neurotomy. Selective tibial neurotomy does not induce permanent triceps muscle weakness or triceps surae-Achilles' tendon complex shortening.Conclusion
This study confirms the long-lasting beneficial effect of selective tibial neurotomy on spasticity, gait speed, and equinovarus deformity in the treatment of spastic equinovarus foot in hemiplegic patients. 相似文献8.
Chia-Lin Chang Michael C. Munin Elizabeth R. Skidmore Christian Niyonkuru Lynne M. Huber Douglas J. Weber 《Archives of physical medicine and rehabilitation》2009,90(9):1462-109
Chang C-L, Munin MC, Skidmore ER, Niyonkuru C, Huber LM, Weber DJ. Effect of baseline spastic hemiparesis on recovery of upper-limb function following botulinum toxin type A injections and postinjection therapy.
Objective
To determine whether baseline hand spastic hemiparesis assessed by the Chedoke-McMaster Assessment influences functional improvement after botulinum toxin type A (BTX-A) injections and postinjection therapy.Design
Prospective cohort study.Setting
Outpatient spasticity clinic.Participants
Participants (N=14) with spastic hemiparesis divided into 2 groups: Chedoke-McMaster Assessment Hand-Higher Function (stage≥4, n=5) and Chedoke-McMaster Assessment Hand-Lower Function (stage=2 or 3, n=9).Interventions
Upper-limb BTX-A injections followed by 6 weeks of postinjection therapy.Main Outcome Measures
Primary outcomes were Motor Activity Log-28 and Motor Activity Log items. Secondary outcomes were Action Research Arm Test (ARAT), Motor Activity Log-Self-Report, and Modified Ashworth Scale (MAS). Measures were assessed at baseline (preinjection), 6 weeks, 9 weeks, and 12 weeks postinjection.Results
Primary and secondary outcomes improved significantly over time in both groups. Although no significant differences in ARAT or MAS change scores were noted between groups, Chedoke-McMaster Assessment Hand-Higher Function group demonstrated greater change on Motor Activity Log-28 (P=.013) from baseline to 6 weeks and Motor Activity Log items (P=.006) from baseline to 12 weeks compared to Chedoke-McMaster Assessment Hand-Lower Function group.Conclusions
BTX-A injections and postinjection therapy improved hand function and reduced spasticity for both Chedoke-McMaster Assessment Hand-Higher Function and Chedoke-McMaster Assessment Hand-Lower Function groups. Clinicians should expect to see larger gains for persons with less baseline impairment. 相似文献9.
Elovic EP Brashear A Kaelin D Liu J Millis SR Barron R Turkel C 《Archives of physical medicine and rehabilitation》2008,89(5):799-806
Elovic EP, Brashear A, Kaelin D, Liu J, Millis SR, Barron R, Turkel C. Repeated treatments with botulinum toxin type A produce sustained decreases in the limitations associated with focal upper-limb poststroke spasticity for caregivers and patients.
Objective
To assess the safety and evaluate the effects of repeated treatments with botulinum toxin type A (BTX-A) on functional disability, quality of life (QOL), and muscle tone of patients with upper-limb poststroke spasticity, as well as its effect on caregivers.Design
Multicenter, open-label, repeated-dose study.Setting
Thirty-five clinical sites in North America.Participants
Patients (N=279) with upper-limb poststroke spasticity at 6 months or more poststroke.Intervention
Up to 5 intramuscular injections of BTX-A (200-400U) divided among the wrist, finger, thumb, and elbow flexors, with at least 200U in the wrist and finger flexors. Retreatment was permitted at 12 weeks or more after the last treatment.Main Outcome Measures
Investigators rated disability using the Disability Assessment Scale and muscle tone using the Ashworth Scale. Each patient's health-related QOL was assessed by using the Stroke Adapted Sickness Impact Profile and the visual analog scale of the European Quality of Life−5 Dimensions questionnaires.Results
Patients treated with BTX-A reported improvements in muscle tone, disability, and ability to function that were statistically significant and clinically meaningful. Significant improvements were observed at week 30 and at subsequent time points in QOL in the overall group and the high-dose group.Conclusions
Up to 5 treatments with BTX-A every 12 weeks for up to 56 weeks in patients with poststroke spasticity was well tolerated and significantly improved muscle tone, lessened disability, and improved patients' QOL. Further research is required to examine the effectiveness of repeated injections of BTX-A in patients with poststroke spasticity. 相似文献10.
Angela S. Lee Jacek Cholewicki N. Peter Reeves Bohdanna T. Zazulak Lawrence W. Mysliwiec 《Archives of physical medicine and rehabilitation》2010,91(9):1327-1331
Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysliwiec LW. Comparison of trunk proprioception between patients with low back pain and healthy controls.
Objective
To determine whether proprioceptive impairments exist in patients with low back pain (LBP). We hypothesized that patients with LBP would exhibit larger trunk proprioception errors than healthy controls.Design
Case-control study.Setting
University laboratory.Participants
24 patients with nonspecific LBP and 24 age-matched healthy controls.Interventions
Not applicable.Main Outcome Measures
We measured trunk proprioception in all 3 anatomical planes using motion perception threshold, active repositioning, and passive repositioning tests.Results
LBP patients had significantly greater motion perception threshold than controls (P<.001) (1.3±0.9° vs 0.8±0.6°). Furthermore, all subjects had the largest motion perception threshold in the transverse plane (P<.001) (1.2±0.7° vs 1.0±0.8° for all other planes averaged). There was no significant difference between LBP and healthy control groups in the repositioning tasks. Errors in the active repositioning test were significantly smaller than in the passive repositioning test (P=.032) (1.9±1.2° vs 2.3±1.4°).Conclusions
These findings suggest that impairments in proprioception may be detected in patients with LBP when assessed with a motion perception threshold measure. 相似文献11.
Fan Gao Thomas H. Grant Elliot J. Roth Li-Qun Zhang 《Archives of physical medicine and rehabilitation》2009,90(5):819-2500
Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.
Objectives
To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle.Design
To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0°, 30°, 60°, and 90° knee flexion in a case-control manner.Setting
Research laboratory in a rehabilitation hospital.Participants
Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10).Interventions
Not applicable.Main Outcome Measurements
At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0° to 90° knee flexion.Results
At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P≤.048) and smaller pennation angle, especially for more extended knee positions (P≤.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P≤.044) and shorter fascicle length (P≤.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05).Conclusions
This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation. 相似文献12.
van Gaal BG Schoonhoven L Mintjes JA Borm GF Hulscher ME Defloor T Habets H Voss A Vloet LC Koopmans RT van Achterberg T 《International journal of nursing studies》2011,48(9):1040-1048
Background
Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously.Objective
This study aimed to test the effect of the SAFE or SORRY? programme on the incidence of three adverse events (pressure ulcers, urinary tract infections and falls). This paper describes Part I of the study: the effect on the incidence of adverse events.Design
A cluster randomised trial was conducted between September 2006 and November 2008. After a three-month baseline period the intervention was implemented followed by a nine-month follow-up period.Settings
Ten wards from four hospitals and ten wards from six nursing homes were stratified for institute and ward type and then randomised to intervention or usual care group.Participants
During baseline and follow-up, patients (≥18 years) with an expected length of stay of at least five days, were asked to participate.Methods
The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for the three adverse events. A multifaceted implementation strategy was used for the implementation: education, patient involvement and feedback on process and outcome indicators. The usual care group continued care as usual. Data were collected on the incidence of adverse events and a Poisson regression model was used to estimate the rate ratio of the adverse events between the intervention and the usual care group at follow-up.Results
At follow-up, 2201 hospital patients with 3358 patient weeks and 392 nursing home patients with 5799 patient weeks were observed. Poisson regression analyses showed a rate ratio for the development of an adverse event in favour of the intervention group of 0.57 (95% CI: 0.34-0.95) and 0.67 (95% CI: 0.48-0.99) for hospital patients and nursing home patients respectively.Conclusion
This study showed that implementing multiple guidelines simultaneously is possible, which is promising. Patients in the intervention groups developed 43% and 33% fewer adverse events compared to the usual care groups in hospitals and nursing homes respectively. Even so, more research is necessary to underline these results.Trial registration
clinicaltrials.gov, number NCT00365430. 相似文献13.
Chetan P. Phadke Sheryl M. Flynn Floyd J. Thompson Andrea L. Behrman Mark H. Trimble Carl G. Kukulka 《Archives of physical medicine and rehabilitation》2009,90(7):1218-92
Phadke CP, Flynn SM, Thompson FJ, Behrman AL, Trimble MH, Kukulka CG. Comparison of single bout effects of bicycle training versus locomotor training on paired reflex depression of the soleus H-reflex after motor incomplete spinal cord injury.
Objective
To examine paired reflex depression changes post 20-minute bout each of 2 training environments: stationary bicycle ergometer training (bicycle training) and treadmill with body weight support and manual assistance (locomotor training).Design
Pretest-posttest repeated-measures.Setting
Locomotor laboratory.Participants
Motor incomplete SCI (n=12; mean, 44±16y); noninjured subjects (n=11; mean, 30.8±8.3y).Intervention
All subjects received each type of training on 2 separate days.Main Outcome Measure
Paired reflex depression at different interstimulus intervals (10s, 1s, 500ms, 200ms, and 100ms) was measured before and after both types of training.Results
(1) Depression was significantly less post-SCI compared with noninjured subjects at all interstimulus intervals and (2) post-SCI at 100-millisecond interstimulus interval: reflex depression significantly increased postbicycle training in all SCI subjects and in the chronic and spastic subgroups (P<.05).Conclusions
Phase-dependent regulation of reflex excitability, essential to normal locomotion, coordinated by pre- and postsynaptic inhibitory processes (convergent action of descending and segmental inputs onto spinal circuits) is impaired post-SCI. Paired reflex depression provides a quantitative assay of inhibitory processes contributing to phase-dependent changes in reflex excitability. Because bicycle training normalized reflex depression, we propose that bicycling may have a potential role in walking rehabilitation, and future studies should examine the long-term effects on subclinical measures of reflex activity and its relationship to functional outcomes. 相似文献14.
Moreau NG Li L Geaghan JP Damiano DL 《Archives of physical medicine and rehabilitation》2008,89(10):2011-2016
Moreau NG, Li L, Geaghan JP, Damiano DL. Fatigue resistance during a voluntary performance task is associated with lower levels of mobility in cerebral palsy.
Objectives
To investigate muscle fatigue of the knee flexors and extensors in people with cerebral palsy (CP) compared with those without motor disability during performance of a voluntary fatigue protocol and to investigate the relationship with functional mobility.Design
A case-control study.Setting
A biomechanics laboratory.Participants
Ambulatory subjects with CP (n=18; mean age, 17.5y) in Gross Motor Function Classification System (GMFCS) levels I, II, and III and a comparison group of age-matched subjects (n=16) without motor disability (mean age, 16.6y).Interventions
Not applicable.Main Outcome Measures
The voluntary muscle fatigue protocol consisted of concentric knee flexion and extension at 60° a second for 35 repetitions on an isokinetic dynamometer. Peak torque for each repetition was normalized by the maximum peak torque value. Muscle fatigue was calculated as the rate of decline in normalized peak torque across all repetitions, represented by the slope of the linear regression. Self-selected and fast gait velocities were measured as well as the Pediatric Outcomes Data Collection Instrument (PODCI).Results
Greater fatigability (slope) was observed in the comparison group for both knee flexors and extensors than in the group with CP. Within CP, lower knee extensor fatigue (slope) was associated with lower functioning GMFCS levels and lower levels of activity and participation as measured by the PODCI transfers and basic mobility.Conclusions
Even after adjusting for maximum peak torque, the knee flexors and extensors of participants with CP were observed to be less fatigable than age-matched peers without motor disability. The lower rate of muscle fatigue was also associated with lower functional mobility in CP. These results may be related to strength or activation differences and/or muscle property alterations. Future investigations are warranted. 相似文献15.
Eun Joo Yang 《Archives of physical medicine and rehabilitation》2009,90(5):741-733
Yang EJ, Rha D, Yoo JK, Park ES. Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography.
Objective
To investigate the accuracy of manual needle placement into gastrocnemius muscle (GCM) for botulinum toxin type A (BTX-A) injection in children with spastic cerebral palsy (CP).Design
Prospective clinical study.Setting
University-affiliated hospital.Participants
A total of 272 injections in GCMs of 39 children with spastic CP who were scheduled to receive BTX-A injections in GCMs.Intervention
Not applicable.Main Outcome Measures
The accuracy of manual needle placement was checked against ultrasonography.Results
The needle was accurately inserted into GCM muscles in 78.7% of cases. Accuracy was 92.6% into gastrocnemius medialis (GM) and 64.7% into gastrocnemuis lateralis (GL). Muscle thickness at the needle insertion site was significantly thinner in GL than GM. Accuracy of GL in the younger age group (<4y, 57.6%) was lower than in the older age group (≥4y, 78.1%). For GM, accuracy in both younger and older age groups was good (>90%).Conclusions
Injection of the toxin into GCMs through the use of anatomic landmark was acceptable in GM, but not acceptable in GL, especially in young children. 相似文献16.
Sepideh Pooyania Karen Ethans Tony Szturm Alan Casey Daryl Perry 《Archives of physical medicine and rehabilitation》2010,91(5):703-707
Pooyania S, Ethans K, Szturm T, Casey A, Perry D. A randomized, double-blinded, crossover pilot study assessing the effect of nabilone on spasticity in persons with spinal cord injury.
Objectives
To determine whether nabilone, a synthetic cannabinoid, alleviates spasticity in people with spinal cord injury (SCI).Design
A double-blind, placebo-controlled crossover study.Setting
Outpatient rehabilitation clinics.Participants
We recruited volunteers (N=12) with SCI and spasticity. One subject, a paraplegic man, dropped out of the study because of an unrelated cause. Eleven subjects completed the study; all subjects were men with an average age of 42.36 years; 6 of them were persons with tetraplegia, and 5 were persons with paraplegia.Interventions
The subjects received either nabilone or placebo during the first 4-week period (0.5mg once a day with option to increase to 0.5mg twice a day), and then outcome measures were assessed. After a 2-week washout, subjects were crossed over to the opposite arm.Main Outcome Measures
The primary outcome was the Ashworth Scale for spasticity in the most involved muscle group, in either the upper or lower extremities, chosen by the subject and clinician. The secondary outcomes included the sum of the Ashworth Scale in 8 muscle groups of each side of the body measured by the clinician; Spasm Frequency Scale and visual analog scale, reported by the subject; Wartenberg Pendulum Test, in order to quantify severity of spasticity; and the Clinician's and Subject's Global Impression of Change.Results
One subject dropped out during the placebo arm because of an unrelated urinary stricture, and 11 subjects completed the study. There was a significant decrease on active treatment for the Ashworth in the most involved muscle (mean difference ± SD, .909±.85; P=.003), as well as the total Ashworth score (P=.001). There was no significant difference in other measures. Side effects were mild and tolerable.Conclusions
Nabilone may be beneficial to reduce spasticity in people with SCI. We recommend a larger trial with a more prolonged treatment period and an option to slowly increase the dosage further. 相似文献17.
Lee HM Chen JJ Wu YN Wang YL Huang SC Piotrkiewicz M 《Archives of physical medicine and rehabilitation》2008,89(4):692-699
Lee H-M, Chen J-JJ, Wu Y-N, Wang Y-L, Huang S-C, Piotrkiewicz M. Time course analysis of the effects of botulinum toxin type A on elbow spasticity based on biomechanic and electromyographic parameters.
Objective
To quantify changes of elbow spasticity over time after botulinum toxin type A (BTX-A) injection in the upper extremity of stroke patients.Design
Before-after trial in which the therapeutic effects were followed up at 2, 6, and 9 weeks after the BTX-A injection (Botox).Setting
Hospital.Participants
Chronic stroke patients (N=8) with upper-limb spasticity.Intervention
BTX-A was injected in upper-limb muscles, including the biceps brachii.Main Outcome Measures
Treatment effects were quantified as the changes in the velocity and the length dependence of hyperexcitable stretch reflexes. Manual sinusoid stretches of the elbow joint at 4 frequencies (1/3, 1/2, 1, 3/2Hz) over a movement range of 60° were performed on patients by using a portable device. The Modified Ashworth Scale (MAS), biomechanic viscosity, and the reflexive electromyography threshold (RET) of the biceps brachii were used to evaluate the degree of hypertonia.Results
The statistical analyses of the MAS score, biomechanic viscosity, and RET revealed a significant decrease in spasticity after the injection (all P<.05). Moreover, our quantitative parameters (biomechanic viscosity, RET) revealed small changes in spasticity after the BTX-A injection that could not be observed from clinical MAS evaluations. Five of 8 subjects showed a maximal reduction in spasticity (in terms of biomechanic viscosity value) within 6 weeks after the injection, whereas it was notable that all subjects exhibited peak RET values at either 2 or 6 weeks after the injection with variable degrees of relapse of spasticity.Conclusions
Early relapse of spasticity (within 9 weeks of the injection) can be detected from biomechanic and neurophysiologic assessments in a clinical setup. These quantitative indices provide valuable information for clinicians when making decisions to perform additional rehabilitation interventions or another BTX-A injection in the early stages of treatment. 相似文献18.
Douglas J. Weber Elizabeth R. Skidmore Christian Niyonkuru Chia-Lin Chang Lynne M. Huber Michael C. Munin 《Archives of physical medicine and rehabilitation》2010,91(5):679-686
Weber DJ, Skidmore ER, Niyonkuru C, Chang C-L, Huber LM, Munin MC. Cyclic functional electrical stimulation does not enhance gains in hand grasp function when used as an adjunct to onabotulinumtoxinA and task practice therapy: a single-blind, randomized controlled pilot study.
Objective
To determine whether onabotulinumtoxinA injections and task practice training with or without functional electrical stimulation (FES) improve upper limb motor function in chronic spastic hemiparesis.Design
Randomized controlled trial.Setting
Outpatient spasticity clinic.Participants
Participants (N=23) had chronic spastic hemiparesis with moderate-severe hand impairment based on Chedoke-McMaster Assessment greater than or equal to 2.Interventions
OnabotulinumtoxinA injections followed by 12 weeks of postinjection task practice. Participants randomly assigned to FES group were also fitted with an orthosis that provided FES.Main Outcome Measures
Motor Activity Log (MAL)-Observation was the primary outcome. Secondary outcomes were Action Research Arm Test (ARAT) and MAL-Self-Report.Results
For the entire cohort, MAL-Observation mean item scores improved significantly from baseline to week 6 (P=.005) but did not remain significant at week 12. MAL-Self-Report mean item scores improved significantly (P=.009) from baseline to week 6 and remained significantly higher (P=.014) at week 12. ARAT total scores also improved significantly from baseline to week 6 (P=.018) and were sustained at week 12 (P=.032). However, there were no significant differences between the FES and no-FES groups for any outcome variable over time.Conclusions
Rehabilitation strategies that combine onabotulinumtoxinA injections and task practice therapy are feasible and effective in improving upper-limb motor function and reducing spasticity in patients with chronic spastic hemiparesis. However, the cyclic FES protocol used in this study did not increase gains achieved with the combination of onabotulinumtoxinA and task practice alone. 相似文献19.
Jason R. Wingert Harold Burton Robert J. Sinclair Janice E. Brunstrom Diane L. Damiano 《Archives of physical medicine and rehabilitation》2009,90(3):447-453
Wingert JR, Burton H, Sinclair RJ, Brunstrom JE, Damiano DL. Joint-position sense and kinesthesia in cerebral palsy.
Objectives
To examine joint-position sense and kinesthesia in all extremities in participants with diplegic or hemiplegic cerebral palsy (CP).Design
Survey of joint-position sense and kinesthesia differences between aged-matched controls and 2 groups with CP.Setting
University movement assessment laboratory.Participants
Population-based sample of participants with CP, diplegia (n=21), hemiplegia (n=17), and age-matched volunteers (n=21) without neurologic disease.Interventions
Not applicable.Main Outcome Measures
Joint-position sense and kinesthesia were measured in the transverse plane (forearm pronation/supination and hip internal/external rotation) using a custom-built device. For joint-position sense, participants actively rotated the tested limb to align the distal end with 10 target positions first with the limb and targets visible to assess their ability to perform the task motorically. The task was then repeated with vision of the limb occluded, with targets remaining visible. Joint-position sense error was determined by the magnitude and direction of the rotation errors for each limb in the vision and no vision conditions. Kinesthesia was evaluated by the ability to detect passive limb rotation without vision.Results
No group differences were detected in the vision condition. Indicative of joint-position sense deficits, a significant increase in errors was found in the no vision condition in all limbs except the dominant upper limb for both groups with CP. Joint-position sense errors were systematically biased toward the direction of internal rotation. Kinesthesia deficits were evident on the nondominant upper limb in diplegia and hemiplegia, and bilaterally in the lower limbs in hemiplegia. In hemiplegia, joint-position sense and kinesthesia deficits were noted on the dominant limbs, but were significantly worse on the nondominant limbs.Conclusions
These results indicate that people with CP have proprioception deficits in all limbs. 相似文献20.
Jean-Michel Gracies Kim Burke Nancy J. Clegg Richard Browne Charter Rushing Darcy Fehlings Dennis Matthews Ann Tilton Mauricio R. Delgado 《Archives of physical medicine and rehabilitation》2010,91(3):421-428
Gracies J-M, Burke K, Clegg NJ, Browne R, Rushing C, Fehlings D, Matthews D, Tilton A, Delgado MR. Reliability of the Tardieu Scale for assessing spasticity in children with cerebral palsy.